OBJECTIVES: Pharmacological treatment of Peripheral Arterial Disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription of these medications but there is little data on the actual use by PAD patients. Our study provides insight into the patient journey through primary and secondary care and the use of medication among patients with newly diagnosed PAD in the Netherlands, based on ‘real-world’ information. METHODS: We conducted a retrospective cohort study among patients newly diagnosed with PAD from 2010-2014 with at least 1-year database follow-up. ‘Newly diagnosed’ was defined as no previous PAD diagnosis record in the database and no prescription of P2Y12-inhibitors or aspirin in the preceding year. Data were obtained from the PHARMO Database Network, a population-based network of electronic healthcare records from primary and secondary healthcare settings in the Netherlands. The source population for this study was defined by the combined catchment areas of the General Practitioner Database and the Outpatient Pharmacy Database and comprised 951,886 individuals. RESULTS: Between 2010-2014 3,929 newly diagnosed PAD patients were identified. Most patients (ca 90%) were diagnosed in primary care and <1% was referred to secondary care within the first 3 months climbing to 11% at the ≥12 months'' timeframe. Overall, half of the patients were prescribed APT (50%). For 1,544 (39%) aspirin with or without statins was recorded as mono-APT. From 418 patients (11%) with documented P2Y12-inhibitor prescription, 7% was as dual-APT with aspirin and 70% as aspirin and statins. The majority of patients were in primary care at the end of the study (83%). CONCLUSIONS: Although Dutch guidelines recommend APT for every PAD patient we observed that 26% of patients had no recorded APT use. This suggests that in the Netherlands daily clinical practice appears not fully congruent with guideline recommendations.